A cluster randomised trial of the program to enhance adjustment to residential living (PEARL): a novel psychological intervention to reduce depression in newly admitted aged care residents

Tanya E Davison,Marita P Mccabe,Daniel W O’Connor,Jessica Byers,Vera Camões Costa,Lucy Busija

doi:10.1186/s12877-020-1492-5

Abstract

BackgroundDepression rates are high in residential aged care (RAC) facilities, with newly admitted residents at particular risk. New approaches to address depression in this population are urgently required, particularly psychological interventions suitable for widespread use across the RAC sector. The Program to Enhance Adjustment to Residential Living (PEARL) is a brief intervention, designed to provide individually tailored care approaches to meet the psychological needs of newly admitted residents, delivered in collaboration with facility staff.MethodsPEARL will be evaluated using a cluster randomised controlled design, comparing outcomes for residents who participate in the intervention with those residing in care as usual control facilities. Participants are RAC residents aged 60 years or above, with normal cognition or mild-moderate cognitive impairment, who relocated to the facility within the previous 4 weeks. The primary outcomes are depressive symptoms and disorders, with secondary outcomes including anxiety, stress, quality of life, adjustment to RAC, and functional dependence, analysed on an intention to treat basis using multilevel modelling.DiscussionPEARL is an intervention based on self-determination theory, designed to reduce depression in newly admitted residents by tailoring day to day care to meet their psychological needs. This simple psychological approach offers an alternative care model to the current over-reliance of antidepressant medications.Trial registrationACTRN12616001726448; Registered 16 December 2016 with the Australian New Zealand Clinical Trials Registry.

Highlights

Depression rates are high in residential aged care (RAC) facilities, with newly admitted residents at particular risk
Depression is common in residential aged care (RAC) settings, with Australian data indicating that approximately one-half of residents live with depressive symptoms [2], while the median prevalence estimate of Major Depressive Disorder (MDD) in an international review of studies was 10% [3]
Current treatment approaches consist almost entirely of antidepressant medications, despite the failure of literature reviews to clearly establish the effectiveness of antidepressants in RAC settings [4], and concerns raised about their low efficacy [5, 6] and adverse effects [5] in older people with dementia in particular

Summary

Introduction

Depression rates are high in residential aged care (RAC) facilities, with newly admitted residents at particular risk. New approaches to address depression in this population are urgently required, psychological interventions suitable for widespread use across the RAC sector. The Program to Enhance Adjustment to Residential Living (PEARL) is a brief intervention, designed to provide individually tailored care approaches to meet the psychological needs of newly admitted residents, delivered in collaboration with facility staff. The field lacks well-validated interventions designed for this elderly, frail and clinically complex population Many existing psychotherapies, such as cognitive behavioural therapy, rely on skilled mental health clinicians, and so are not feasible for widespread use in Australian facilities, where there has traditionally been limited access to specialist psychological services [8].

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